Obesity Intervention for Adolescents - Research Paper Example

Obesity is one of the major public health concerns worldwide, most specially in the United States. According to Schwarz and Peterson (2010) of the National Center for Children in Poverty (NCCP), one out of every six adolescents is overweight while one out of every three is at risk (n.p.). In addition, obesity among adolescents in the United States is highest among Black American girls with 29.2% prevalence and publicly insured adolescent girls with 24.8% respectively (Schwarz & Peterson, 2010, n.p.). Despite increasing prevalence and severity of obesity among children and adolescents, very few studies about interventions focusing on improving healthy lifestyle and behaviors such as nutritional habits and physical activity of adolescents have been conducted. Thus, the main aim of this paper is to provide a literature review of three articles concerning obesity interventions for adolescents. Review of Related Literatures Article 1: Sabet Sarvestani, R., Jamalfard, M.H., Kargar, M., Kaveh, M.H. & Tabatabaee, H.R. (2009). Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls. Journal of Advanced Nursing, 65(8): pp. 1670–1675. doi: 10.1111/j.1365-2648.2009.05029.x The main purpose of the study was a two-fold objective: one was to evaluate the effects of behavior modification on anthropometric indices and the other one was to explore improvement in eating behavior of adolescents if behavior modification would be used as an intervention. Variables were not explicitly stated but based on the title, the independent variable was the dietary behavior modification and the dependent variables were anthropometric indices and eating behavior. Samples included 30 obese adolescents aged 11-15 years and the research design adopted for the study was a quasi-experimental design. Methods employed include sample size calculation based on previously reported intervention changes in weight and body mass index (BMI) in children, behavior modification or dietary instruction, and yoga therapy. Instruments used in the data collection include the BMI and the Dutch Eating Behavior Questionnaire (DEBQ) Score. The data collection procedure involved taking the data before and after the program. Body weight, height, and arm circumferences were also measured and BMI was calculated by dividing the weight in kilograms by the squared height in centimeter square. BMI above the 95th percentile indicated obesity (Sabet Sarvestani, Jamalfard, Kargar, Kaveh & Tabatabaee, 2009, 1672). The SPSS version 11.5 was used to analyze the data, including the descriptive and analytic tests and the statistical significance P < 0. 05. Differences between the control and experimental group were determined using the two-sample t-tests while the evaluation of the effect of the program employed sequential analysis. Results found no statistical differences between the characteristics of the control and experimental groups; however, statistical significant differences in terms of changes in anthropometric indices after 6 months and improvement in the three DEBQ subscales for eating behavior were found. The strengths of the study included the appropriate statistical measures for achieving decrease in body weight, BMI, arm circumferences and improvement in eating behavior whereas limitations included small sample size and 20% withdrawal rate. Article 2: Chen, J., Weiss, S., Heyman, M.B., Cooper, B. & Lustig, R.H. (2011). The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (web ABC study). Journal of Adolescent Health, 49: pp. 148-154. doi:10.1016/j.jadohealth.2010.11.243 The purpose of the study was to examine the efficacy of Web ABC program in promoting healthy lifestyles and healthy weight in Chinese American adolescents (Chen, Weiss, Heyman, Cooper & Lustig, 2011, 148). The independent and dependent variables were not explicitly stated but were implied to be the delivery of web-based childhood obesity prevention program and the efficacy itself of the program. Samples comprised 54 adolescents who are 12-15 years old, overweight or of normal weight adolescents based on CDC recommendation, adolescents who were in good health, and adolescents and parents of Chinese origin who can speak or read English, Mandarin, Cantonese, or Chinese. The study utilized a randomized control study design to meet the objective. The conceptual/theoretical framework of the study was based on the Transtheoretical Model-Stages of Change and on the social cognitive theory to match with the behavioral stage development of adolescent. Methods employed include: completion of questionnaires regarding adolescents’ dietary intake, nutritional and physical activity knowledge, and self-efficacy in terms of physical activity and healthy food choices; completion of questionnaires by the mother about parents’ demographic information and levels of acculturation; setting of inclusion criteria; and data collection between October 2007 and May 2009. Data collection instruments varied among parents and children. Parental measures instruments included a 12-item questionnaire about family information and a 21-item multiple-choice questionnaire Suinn-Lew Asian Self-Identity Acculturation Scale. On the other hand, children measures included body mass index, waist-to-hip ratio, blood pressure, actigraph, three-day food diary, physical activity knowledge, dietary questionnaire or health behavior knowledge, self-reported questionnaire about child dietary self-efficacy, and health behavior questionnaire about physical activity self-efficacy. Data collection was through the children and parental inputs in the internet or website. Descriptive statistics such as t-tests, linear mixed effects models, and SPSS version 17 were used to analyze the data. In addition, a power analysis was used to detect a moderate difference in the BMI of the two groups. Results geared adolescents with mean age of 12.52 and standard deviation of 3.15 years. Nineteen of the samples were obese or overweight and there was no difference in baseline variables and log on rate between the groups. In addition, significantly more adolescents in the intervention group had decreased waist-to-hip ratio and DBP while physical activity, vegetable and fruit intake, and knowledge related to physical activity and nutrition have increased. While no outcome variables differed significantly in the control group, follow-up t-tests found that DBP, physical activity, vegetable and fruit intake, knowledge related to physical activity and nutrition, and waist-to-hip ration differed significantly. The strengths of the study included the parents’ participation in the study, the interactive nature and individualization of the program which had contributed to its success, and being the first to examine feasibility and efficacy of Web-based behavioral intervention program among Chinese American adolescents and families. Meanwhile, limitations included used of convenience sampling, self-report measures, selection measures involving only of parents with high education and Chinese American adolescents, and a 6-months follow-up after the intervention. Article 3: Melnyk, B.M., Jacobson, D., Kelly, S., O’Haver, J., Small L. & Mays, M.Z. (2009). Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: a randomized controlled pilot study. Journal of School Health, 79(12): pp. 575-584. The purpose of the study was to determine the short-term preliminary efficacy of COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, and Nutrition) program on the mental, healthy lifestyle beliefs and choices, and physical health outcomes of Hispanic adolescents (Melnyk, Jacobson, Kelly, O’Haver, Small & Mays, 2009, 575). Based on the identification of the experimental interventions, the independent variable was the COPE Healthy Lifestyles TEEN program while dependent variables were mental health, healthy lifestyle beliefs and choices, and physical health. Samples consisted of 19 adolescents attending an urban, predominantly Hispanic high school in a metropolitan southwest city and enrolled in 1 of two sections of required health course. The study utilized a 2-group cluster randomized controlled pilot study with preinterventions and postintervention measures. The cognitive behavioral therapy (CBT) served as the theoretical framework of the study. Methods employed include seeking approval from the Office of Research Integrity and Assurance at Arizona State University, randomization by class of study group, application of study instruments, implementing the experimental interventions, and observance of the attention control group. Data collection instruments included in the study were the Healthy Lifestyle Beliefs Scale, the 20-item questionnaire on nutrition knowledge, the Healthy Lifestyle Choices Scale, the Beck Youth Inventory Second Edition, baseline and postintervention anthropometric measures with Tanita Scale used in height measurement, and the different laboratory works. After approval from institutional review board and administrators from Arizona State University, data collection started from August to October 2007. Needed parental consent and adolescent assent were done and samples were randomly selected and blinded to the experimental interventions. Both groups received two interventions with similar techniques and the content-specific experimental interventions were delivered 2-3 times a week for 9 weeks period. Data were collected from participating students of the study. Meanwhile, data analysis yielded a total of 17 participants who completed baseline and postintervention data. Data analysis was restricted to these participants and t tests were conducted on continuous variables while chi square tests were conducted on categorical variables in order to determine the equivalence of the experimental and control groups at baseline. On the other hand, independent and paired sample t tests were conducted to evaluate the effects of the program using .10 as the set level of significance for p value. Two members of the research team compiled and extracted the program feedback through independent iterative summaries. Results of the study have found that there were no significant statistical differences between the BMI of the two groups and the continuous variables, except on height. Result of the paired t tests found that teens in the COPE intervention group were less depressed, less anxious, and more committed to making healthy choices following the intervention whereas teens in the control group showed no appreciable change in depression or anxiety, but a similar change in commitment to making healthy choices as all students were enrolled in a health class (Melnyk, Jacobson, Kelly, O’Haver, Small & Mays, 2009, 580). In addition, paired t tests also indicated increased in nutritional knowledge, beliefs, healthy lifestyle choices, physical activity, and HDLs; whereas, depressive symptoms, hemoglobin A1C, and triglycerides decreased. Strengths of the study included appropriate aim for achieving outcome and the inclusion criteria that removed barriers in previous research; whereas limitations included small convenience sample, cluster randomization to avoid cross contamination, and assessment of short-term outcomes. In general, the COPE intervention program was found to be informative, helpful, and well-recommended by the high school students. Comparison and Contrast The research articles may differ in a number of ways but they also share some commonalities, among of which include: purpose geared towards evaluating the effects or efficacy of each experimental intervention in promoting healthy behavior, healthy lifestyles, and healthy weight; the independent and dependent variables were not explicitly stated in the articles; used of convenience sampling and small sample size; and utilization of quantitative research design with experimental group and controlled group. In addition, all of the research articles were conducted in short-term duration (< 1 year). On the other hand, differences among the three research articles include: experimental interventions that include dietary behavior modification, web-based childhood obesity prevention program, and COPE Healthy Lifestyles TEEN program; race or ethnic of the samples that included Iran adolescents, Chinese Americans, and Hispanics Americans adolescents; and age categorization of adolescents (whether adolescent samples include 11-15 years old, 12-15 years old, or 14-16 years old). All of the research articles adopt the quantitative research design but differed whether quantitative design used quasi-experimental, randomized-controlled study, or two-group cluster randomized-controlled study designs, respectively. Conclusion The increasing prevalence of obesity in the United States and the limited availability of research/studies concerning interventions at improving healthy lifestyle and behaviors were the major reasons that prompted the pursuit of the three research articles reviewed. Central to the body of research were the issues about the effects of behavior modification as intervention on promoting healthy lifestyles and weight among participants. The theoretical/conceptual models used in the articles were framed on how behavior can be molded such as the Transtheoretical Model-Stages of Change, the social cognitive theory, and the cognitive behavioral therapy (CBT). Hypotheses and research questions were aimed towards determining the effects/efficacy of a certain behavioral intervention in achieving healthy outcomes among obese or overweight adolescents. All of the articles were experimental in design and involved adolescents as participants of the study; thus, proper consent both from the parents and adolescents was sought. In addition, commonalities in experimental interventions such as behavior modification, dietary instruction, physical activity, and BMI calculation were applied in the studies to solve the problem. Results of the research articles found no significant statistical differences between the characteristics of the groups under study. Meanwhile, statistical differences were noted in adolescents who participated in the studies because improvement in nutritional knowledge, eating behavior, physical activity, and anthropometric measures were reflected on the results. Reliability and validity measures were missing in two of the reviewed articles and most of the inadequacies of the articles pointed small sample sizes, short periods of studies, and attrition rates as the issues to address in further research. Research Question for Future Study In overweight/obese female Hispanic adolescents aged 10 to 19 years, how does COPE TEEN program compared to traditional dietary counseling affect anthropometric indices, eating behavior, physical activity, and mental health? Recommendation After learning the different limitations of each article, the author recommends a follow-up study involving larger populations and time-framed of a year. These limitations must be addressed in order to generalize the findings in a larger population. In addition, the use of convenience sampling in the three articles may also limit generalizability of findings because sampling is bias and chosen according to proximity or convenience and which may eventually lead to low representativeness of the population as well as having low validity. The author suggests a stratified random sampling where there would be representatives of different races (e.g., Hispanic American, Asian American, African American, etc.). References Chen, J., Weiss, S., Heyman, M.B., Cooper, B. & Lustig, R.H. (2011). The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (web ABC study). Journal of Adolescent Health, 49: pp. 148-154. doi:10.1016/j.jadohealth.2010.11.243 Melnyk, B.M., Jacobson, D., Kelly, S., O’Haver, J., Small L. & Mays, M.Z. (2009). Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: a randomized controlled pilot study. Journal of School Health, 79(12): pp. 575-584. Sabet Sarvestani, R., Jamalfard, M.H., Kargar, M., Kaveh, M.H. & Tabatabaee, H.R. (2009). Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls. Journal of Advanced Nursing, 65(8): pp. 1670–1675. doi: 10.1111/j.1365-2648.2009.05029.x Schwarz, S.W. & Peterson, J. (2010). Adolescent Obesity in the United States: Facts for Policymakers (n.p). New York: National Center for Children in Poverty. Retrieved on April 23, 2012 from http://nccp.org/publications/pdf/text_977.pdf Read More